Vision Therapy

Coverage decision

The department will cover office based vision therapy for treatment of convergence insufficiency (CI) when traumatic brain injury is an allowed condition on the claim. All other cases of CI will require additional review.CI can occur without traumatic brain injury. Individuals with long standing CI are likely to have amblyopia or reduced vision in one eye and also have a history of prism use or strabismus prior to the industrial injury.

Non-covered indications:
The department will not authorize payment for vision therapy as a treatment for

Unspecified brain disorder,

Convergence excess,

Divergence insufficiency and divergence excess,

Accommodative insufficiency,

Asthenopia.

Number of sessions allowed: The department will allow 12 office based vision therapy treatments. For additional treatments to be authorized, objective evidence of improvement (e.g. near point convergence (NPC) and positive fusional vergence at near) should be documented.

Billing Codes

CPT ® Code

92065 - Orthoptic and/or pleoptic training

For additional information, please see the complete coverage decision below: